General interest items edited by Janice Flahiff

There are now hundreds of flashy “cold and flu” products, but still only a handful of simple, cheap ingredients. Here’s one new way to cut through the noise.

One in four people, when buying an over-the-counter medicine to treat a headache, will go for a brand name product. Unless that person is a pharmacist. In that case, according to research from the National Bureau of Economic Research, they’ll almost certainly buy a generic version. The pharmacists know, and trust, that the drugs are identical.

But Bayer aspirin costs $6.29 at CVS, while the same amount of CVS-brand aspirin costs less than a third of that, $1.99. The two products are required by law to be “bioequivalent,” and CVS even has signs imploring shoppers to go for the cheaper option. Yet many people do no such thing. The difference in price between brand names and generics accounts for tens of billions of dollars “wasted” every year by Americans in pharmacies, according to the economics researchers. They also found that more highly educated people are more likely to buy generic medications, concluding that “misinformation explains a sizable share of the brand premium for health products.”

Consumer confusion, or misplaced trust, is compounded by the fact that a drug store is likely to have upwards of 300 cold-and-flu products.

…

Angelotti, formerly at Google, has now co-created a program that can help people pare down their options. On the Iodine site, you can click on the symptoms you’re experiencing, and that will comb a database of common cold-and-flu products and tell you which ones meet your needs. The results also include product reviews (via Google, with over 100,000 medication reviews so far), dosage forms (liquid or pill), active ingredients, and the names of generic versions at various pharmacies.

[janice’s note…it would still be wise to consult with an expert…as in a licensed pharmacist!]

Researchers take a page from weather forecasting to predict seasonal influenza outbreaks in 108 cities across the country

Scientists were able to reliably predict the timing of the 2012-2013 influenza season up to nine weeks in advance of its peak. The first large-scale demonstration of the flu forecasting system by scientists at Columbia University’s Mailman School of Public Health was carried out in 108 cities across the United States.

Results are published online in the journal Nature Communications.

The flu forecasting system adapts techniques used in modern weather prediction to turn real-time, Web-based estimates of influenza infection into local forecasts of the seasonal peak by locality. Influenza activity peaked in cities in the southeast as early as December 2012, but crested in most of the country in the first weeks of 2013.

Year to year, the flu season is highly variable. It can happen anywhere from December to April. But when it arrives, cities can go from practically no cases to thousands in a very short time. “Having greater advance warning of the timing and intensity of influenza outbreaks could prevent a portion of these influenza infections by providing actionable information to officials and the general public,” says first author Jeffrey Shaman, PhD, assistant professor of Environmental Health Sciences at Columbia University’s Mailman School of Public Health.

For the public, the flu forecast could promote greater vaccination, the exercise of care around people sneezing and coughing, and a better awareness of personal health. For health officials, it could inform decisions on how many vaccines and antiviral drugs to stockpile, and in the case of a virulent outbreak, whether other measures, like closing schools, are necessary.

Study Results

The new study builds on the researchers’ 2012 study that used the system to retrospectively predict the peak of the flu in New York City for the years 2003-2008. That research was limited to one city and performed as a test of the system. The current study is the first to make predictions in actual real-time and for the whole country.

Beginning in late November of 2012, the researchers used the flu forecasting system to perform weekly estimates for 108 cities. They shared the results with the CDC and posted them online in an academic archive. Near the end of 2012, four weeks into the flu season, the system had predicted 63% of cities accurately. As the season progressed, the accuracy increased. By week four, it successfully predicted the seasonal peak in 70% of the country. It was able to give accurate lead-times up to nine weeks in advance of the peak; most lead-times were two to four weeks.

The flu forecasts were also much more reliable than those made using alternate, approaches that rely on historical data. “Our method greatly outperformed these alternate schemes,” says Dr. Shaman.

The researchers saw regional differences in the accuracy of the system, but they were likely within normal variation. “As an example, retrospectively, we’ve been able to predict the flu in Chicago very well; this year we did a terrible job in that city. For other cities, the opposite held. It averages out. On the whole the system performed very well,” Dr. Shaman says. However, there were hints of geographical differences. “We were able make better predictions in smaller cities. Population density may also be important. It suggests that in a city like New York, we may need to predict at a finer granularity, perhaps at the borough level. In a big sprawling city like Los Angeles, we may need to predict influenza at the level of individual neighborhoods.”

Google Flu Trends Goes “Off the Rails”

The researchers designed the flu forecasting system to use combined data from 1) Google Flu Trends, which makes estimates of outbreaks based on the number of flu-related search queries, and 2) region-specific reports from the Centers for Disease Control on verified cases of flu. The system approach is analogous to weather forecasting, which employs real-time observational data to reduce model forecasts error. In the last year, the researchers slightly modified the system to be more representative of flu rather than flu and other respiratory problems. Nevertheless, there was unusual level of “noise” in the data related to problems with Google Flu Trends.

How did this happen? One explanation is the high number of media stories about the flu, including some about the flu forecasting system itself. The result was a spike in people using Google to research the flu, which could have overloaded the Flu Trends algorithm. It’s an irony not lost on Dr. Shaman. “There was a tremendous amount of media attention accorded to the flu last year. I was part of the problem myself,” he says. Another factor may have been the particular strain of flu in circulation. “The flu was very virulent and was making people very sick, more so than previous seasons,” says Dr. Shaman. Again this could have led to spike in flu-related Google search queries. (In October, Google announced that it has revised the Flu Trends, which Dr. Shaman hopes will make flu forecasting more accurate.)

The system will be put back in action as soon as the flu season begins again. “Right now there are few cases of the flu, but as soon as the needle starts to move, we will start making predictions,” says Dr. Shaman. This season the forecasts will be more readily available to the public on a website hosted by Columbia’s Mailman School of Public Health expected to launch in the coming weeks.

Worldwide, influenza kills an estimated 250,000 to 500,000 people each year, according to the World Health Organization. In the U.S. 3,000-49,000 die from the flu every year, and about 45% of Americans were vaccinated for the flu, according to the CDC.

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Co-authors include Wan Yang and James Tamerius, post-doctoral students of Dr. Shaman (Dr. Tamerius is currently at the University of Iowa); Alicia Karspeck at the National Center for Atmospheric Research; and Marc Lipsitch at the Harvard School of Public Health.

Funding was provided by the National Institutes of Health (GM100467, ES009089) and the Department of Homeland Security. Dr. Lipsitch discloses consulting or honorarium income from the Avian/Pandemic Flu Registry (Outcomes Sciences; funded in part by Roche), AIR Worldwide, Pfizer and Novartis. All other authors declare no competing financial interests.

Great presentation! complete with graphs (you might need to pause to read them, as I did!)
Language is a bit earthy, but not vulgar
Only negative comment I have…
Speaker said to stay home if you have flu, it is not the end of the world if you do stay home.
Perhaps not, but for those in low paying jobs without paid sick days, it is a very difficult choice to make…the money is needed just for basics as food…

newswise — Monitoring Internet search traffic about influenza may prove to be a better way for hospital emergency rooms to prepare for a surge in sick patients compared to waiting for outdated government flu case reports. A report on the value of the Internet search tool for emergency departments, studied by a team of researchers at Johns Hopkins Medicine over a 21-month period, is published in the January 9 issue of Clinical Infectious Diseases.

The researchers reported a strong correlation between a rise in Internet searches for flu information, compiled by Google’s Flu Trends tool, and a subsequent rise in people coming into a busy urban hospital emergency room complaining of flu-like symptoms….

PITTSBURGH—The flu shot, typically the first line of defense against seasonal influenza, could better treat the U.S. population, thanks to University of Pittsburgh researchers.

New research that focuses on the composition and timing of the shot design was published in the September-October issue of Operations Research by Pitt Swanson School of Engineering faculty members Oleg Prokopyev, an assistant professor, and Professor Andrew Schaefer, both in the Department of Industrial Engineering, and coauthors Osman Ozaltin and Mark Roberts, professor and chair in Pitt’s Department of Health Policy and Management. Ozaltin, who is now an assistant professor of engineering at the University of Waterloo in Ontario, did his research for the study as a Pitt graduate student in the Swanson School; he earned his Pitt PhD degree in industrial engineering earlier this year.

The exact composition of the flu shot is decided every year by the Food and Drug Administration (FDA), and the decision is complicated.

“The flu’s high rate of transmission requires frequent changes to the shot,” said Prokopyev. “Different strains can also cocirculate in one season, which gives us another challenge for figuring out the composition.”

The Pitt researchers used powerful optimization methods from engineering to examine whether they could improve the yearly decisions made regarding what strains of influenza should be included in the current year’s vaccine. The strains of flu that will be most likely to appear in the regular flu season are not known with certainty, but waiting longer to finalize the composition of the vaccine and observing what strains are occurring in other parts of the world improves the accuracy of the selection. However, the longer the FDA waits to make the decision, the more likely it is that there will be insufficient vaccine produced by the start of flu season. The model developed by the Pitt researchers balances these two important characteristics of the flu selection decision and integrates the composition and timing decisions of the flu shot design….

During the 1918 to 1920 global influenzaepidemic, between 50 to 100 million people lost their lives, with over a quarter of the world’s population having being infected. Although vaccines might help in the event of a similar outbreak today, the possibility still remains that vaccine production would not be able to cope with such an influx in demand to make an important impact. In addition, hospitals would probably be overstretched, leaving many patients to be cared for by family members at home.

According to Richard Larson and Stan Finkelstein, members of MIT’s Engineering Systems Division (ESD), non-pharmaceutical interventions (NPIs) would be critical in these situations to minimize the spread of infection. Larson and Finkelstein want to inform people on how to avoid flu from spreading amongst family members and those living or working in close quarters. Larson, Mitsui Professor of Engineering Systems explains:

“We thought, let’s look at the dynamics of the home and see if there are any reasonably inexpensive steps that people could take to care for their loved ones and simultaneously minimize the chance of getting infected.”

They discovered that following simple steps, such as washing hands properly, wearing masks and strategically controlling temperature, humidity and air circulation, could all assist in decreasing the risk of flu from spreading. Even though their recommendations are based on fighting pandemic flu, these measures could also prevent the spread of the common seasonal flu, which typically kills about 30,000 people each year in the U.S. ….

There is a lot of information about flu vaccines and the effects it has on the human body. Most of the information regarding flu vaccines is true and factual, and is often disseminated through publications and fact sheets authored by members of such organizations as the Center for Disease Control and Prevention, the Massachusetts Department of Public Health, and the national office of Health and Human Services.

However, there are still misconceptions about the flu vaccine. This post will offer another avenue for correct information that keeps Boston healthy and happy.

Myth 1: Flu shots can cause the flu

All vaccines contain an inactive sample of the virus it’s meant to fight. The same is true for the flu vaccine. The body recognizes these inactive flu viruses and makes antibodies to destroy them. When an active flu virus is present in the body, the body already has stored antibodies that can and will attack the flu virus.

Myth 2: Flu shots can cause autismThis myth has gained considerable notoriety as GOP presidential candidate Michele Bachmann recited this misconception. The flu vaccine contains thimerosal, a preservative that has mercury. Thimerosal has been linked to many health problems, including autism. However, health and medical professionals agree that a small exposure to thimerosal will cause no more harm than some minor red irritation at the injection area.

Myth 3: Flu shots received late in the flu season are ineffective at preventing the flu

Some people believe that getting a flu shot after November is pointless. However, it is never too late to start protecting yourself. Although it is recommended that one gets a flu shot early in the season, for ample protection time. The flu season typically lasts as long as the winter season. Especially in Boston, residents can expect exposure to the flu until late February or even early March.

Myth 4: Flu shots protect for many years

Unlike most vaccines, the flu shot should be given annually. Every year the flu virus changes and new vaccines are needed so the body can continue to protect against the flu.

Myth 5: Babies should get flu shots

Although babies under the age of 6 months are at risk of catching the flu, it is not recommended that infants under 6 months get a flu shot. Instead, parents and other members of the family should get vaccinated and lessen the risk of passing the flu to their infant children.

Myth 6: Any and everyone should get a flu shot

Those who have a severe allergy to chicken eggs should not get the flu vaccine. Also, those people who have allergies to any of the other substances in the vaccine should talk to a health professional about whether or not the vaccine is a healthy choice for them. Those people who have had bad reactions to the vaccine in the past should forgo the vaccine now, too.

Myth 7: One flu shot in the season is not enough

One flu shot per flu season is enough to protect an adult against the flu. Only kids 6 months to eight years old who have no previous history of getting the flu shot, should get a second at least four weeks after the first dose.

Myth 8: The flu shot is the only option

There is also the nasal spray that protects against the flu virus. The spray is for healthy people age 2-49 who are not pregnant.

Related Blog item

This week is National Influenza Vaccination Week (is there a Hallmark card for that?), which got me wondering whether urban dwellers have better immune systems because they’re exposed to so many people–and germs. After all, a subway car is not too dissimilar to a daycare center: uncovered coughs, shoving, and issues with sharing abound. And we know that in the long term, kids in daycare have stronger immune systems.

Without spending too much time researching this question, I came across an interestingNational Geographic piece that illustrated the impact ancient cities have had on bolstering present-day immunity. At the same time, however, a quick glance at this Google Map tracking the spread of H1N1 reminds us that urban areas were particularly hard-hit.

Like this:

CDC Issues Initial 2011-2012 Seasonal FluView Reporthttp://www.cdc.gov/media/releases/2011/p1014_fluview_report.html
The Centers for Disease Control and Prevention has released the initial FluView report for the U.S. 2011-2012 flu season with the message that flu activity is currently low, making this the perfect time to get vaccinated.

Influenza researchers have found that flu strains migrate back and forth between different regions of the world, evolving along the way. This is contrary to the common belief that flu strains from the tropics are the source of global seasonal epidemics.

“This study helps us to better understand why the persistence, movement and evolution of flu viruses are complex and largely unpredictable,” said NIAID Director Anthony S. Fauci, M.D. “These findings also remind us of the importance of maintaining vigilance in our global influenza surveillance efforts.”

Previous studies had shown that in general, influenza viruses in tropical regions tend to be more varied and circulate year-round rather than seasonally, like flu viruses found in temperate regions with more moderate climates. The prevailing theory had been that tropical areas of the world may be the source of flu viruses from which new seasonal flu strains originate….

…

none of the seven temperate and tropical regions they examined was the source of all new H3N2 flu strains in a given year. The migration pattern was more complex. Virus strains moved from one region to several others each year, and flu outbreaks were traced back to more than one source. And although the virus that migrated between Southeast Asia and Hong Kong persisted over time, its persistence was caused by the introduction of virus from the temperate regions. Therefore, the tropical regions did not maintain a source for the annual H3N2 influenza epidemics. Further, in contrast to annual flu epidemics in temperate climates, relatively low levels of genetic diversity among flu strains and no seasonal fluctuations were found in the tropical regions.

“We found that the H3N2 influenza virus population is constantly moving between regions, and every region is a potential source for new epidemics,” said Dr. Bahl. “Regions with more connections to others, such as travel centers, may contribute more to the global diversity of circulating viruses.”

The complexity of the global virus circulation found in the study suggests that efforts to control flu should include region-specific strategies, according to the researchers. In future studies, the researchers intend to examine whether the virus behaves differently in temperate and tropical areas, including regions not included in this analysis, and in places that are more or less connected to the rest of the world.

…During the 2009 H1N1 pandemic, however, the Public Health Informatics and Technology Program Office at the CDC together with various partners used simulated data to explore how a decentralized information architecture run on the Public Health Grid (PHGrid) might be used to acquire relevant data quickly, securely and to effectively model the spread of disease. The main advantage of building the system on the PHGrid is that it allows for disparate, distributed data and services to be used by the public health community and so avoids the obstacles seen with repurposing specialized surveillance systems.

“The speed with which public health officials can identify, respond, and deploy interventions in response to public health events has the potential to change the course or impact of a disease,” the team explains. The PHGrid framework could be used to address specific surveillance needs such as those related to novel pandemic influenza in 2009. By using advances made by the “grid” community in health and other fields, PHGrid was able to focus on specific issues without having to re-invent and re-evaluate the information technology needed by using established data tools and formats. Such an approach also avoided the need to find ways to circumvent bugs and problems that would have arisen had new technology been developed at the time for the specific purpose. …

Existing plans for antiviral and antibiotic use during a severe influenza pandemic could reduce wastewater treatment efficiency prior to discharge into receiving rivers, resulting in water quality deterioration at drinking water abstraction points.

The research was carried out by a team from the Centre for Ecology & Hydrology (UK), the Institute for Scientific Interchange (Italy), Utrecht University (Netherlands), the University of Sheffield (UK), and Indiana University (USA).

The global public health community closely monitored the unfolding of the 2009 H1N1 influenza pandemic to best mitigate its impact on society. However, little attention was given to the impact that the medical response might have on the environment.

In order to evaluate this risk, the research team coupled a global spatially-structured epidemic model that simulates the quantities of antiviral and antibiotics used during an influenza pandemic of varying severity, with a water quality model applied to the Thames catchment in southern England to predict their environmental concentrations. An additional model was then used to assess ecotoxicologic effects of antibiotics and antiviral in wastewater treatment plants (WWTP) and rivers.

The research team concluded that, consistent with expectations, a mild pandemic (as in 2009) was projected to exhibit a negligible ecotoxicologic hazard. However in a moderate and severe pandemic nearly all WWTPs (80-100%) were projected to exceed the threshold for microbial growth inhibition, potentially reducing the capacity of the plant to treat wastewater. In addition, a proportion (5-40%) of the River Thames was similarly projected to exceed key thresholds for environmental toxicity, resulting in potential contamination and eutrophication at drinking water abstraction points.

Lead author Dr Andrew Singer, from the Centre for Ecology & Hydrology, said, “Our results suggest that existing plans for drug use during an influenza pandemic could result in discharge of inefficiently treated wastewater into the UK’s rivers. The potential widespread release of antivirals and antibiotics into the environment may hasten the development of resistant pathogens with implications for human health during and potentially well after the formal end of the pandemic.”

Dr Singer added, “We must develop a better understanding of wastewater treatment plants ecotoxicity before the hazards posed by a pandemic influenza medical response can be reliably assessed. However, the production and successful distribution of pre-pandemic and pandemic influenza vaccines could go a long way towards alleviating all of the identified environmental and human health problems highlighted in our paper, with the significant added benefit of reducing morbidity and mortality of the UK population. This latter challenge of vaccination is probably society’s greatest challenge, but also where the greatest gains can be made.”

American and Canadian researchers confirmed that resistance to the two approved classes of antiviral drugs can occur in several ways and said this dual resistance has been on the rise over the past three years.

On November 19, Jason Martin returned to the Medical Intensive Care Unit (MICU) at Vanderbilt University Medical Center for the first time since he nearly died there during last year’s H1N1 flu pandemic. The tall and burly Warren County, TN, ambulance worker – a 30-year-old, father of three young children – broke down and hugged some of the nurses he recognized.

“I got sick on September 12 and didn’t come out of it for the next 20 days. I am just so grateful I came through,” Martin said, wiping his eyes.

Martin was among the first wave of critically ill middle Tennesseans, hit hard by the H1N1 flu pandemic in late 2009. A hallmark of pandemic flu throughout history, including the H1N1 pandemic, has been its ability to make healthy young and middle-aged adults seriously ill and even kill this population in disproportionate numbers.

In a paper published Dec. 5 in Nature Medicine, Fernando Polack, M.D., the Cesar Milstein Associate Professor of Pediatrics at Vanderbilt, and colleagues in Argentina and Nashville provide a possible explanation for this alarming phenomenon of pandemic flu. The study’s findings suggest people are made critically ill, or even killed, by their own immune response…

…

“We have seen this before. Where non-protective antibody responses are associated with an immune-based disease in the lung,” Polack said.

Polack has previously published evidence that a first-line immune response, primed by an imperfect antibody, can overreact in a violent and uncontrolled fashion. Patients die from lung damage inflicted by their own immune system. A molecule called C4d, a product of this biochemical cascade (the complement system), is a marker for the strength of the response.

In adults who died during the 2009 H1N1 pandemic, high levels of C4d in lung tissues suggest a massive, potentially fatal activation of the complement system.

Pulmonary and critical care physician, Todd Rice, M.D., assistant professor of Medicine at VUMC, has seen people killed by the “exuberant” and uncontrolled response of the immune system in other diseases – like sepsis….

…

While many questions remain, one thing is clear: the H1N1 vaccine offers protection. Patients who died were overwhelmingly unvaccinated. Many fell ill before a vaccine was even available. [Editor Flahiff’s empahsis]

“Reports of pertussis have reached startling numbers in communities around the nation in recent months, leading to
renewed attention to the common infectious disease. Several states are currently reporting pertussis outbreaks, from California to Michigan to South Carolina…”

Like this:

Have a minute? Click here for a short video on getting ready for flu season.
MedlinePlus (a gold mine of trusted health information) has additional flu related information at Childhood Immunization and Flu. Also, consider visiting flu.gov for a wealth of current influenza information gathered from many branches of the US federal government.

The American Academy of Family Physicians, however, says not everyone is a candidate for the nasal vaccine. The academy says the following people should talk with their doctor before getting the spray:

Children under age 2, or adults 50 and older.
Anyone with a chronic health problem or a compromised immune system.
Children or teens who take long-term aspirin therapy.
Anyone who has heart, kidney or lung disease, or diabetes.
Women who are pregnant.
Anyone who has had Guillain-Barré syndrome.
Anyone who has had an allergic reaction from a flu vaccine, or who is allergic to eggs.

Health and Human Services (HHS) officials have recently looked at a new model of school-based immunization clinics. They believe it is an efficient way to deliver the pandemic vaccine to children. However, most schools would need more resources to hold future clinics.

“They found that sites vaccinated an average of 28% of enrolled students during 1-day programs, which federal officials said compares favorably with state and national vaccination rates. For example, the average vaccination rate for the six states included in the study is 37%, which reflects a child vaccination period of about 3 months at multiple sites such as doctor’s offices, pharmacies, and community clinics. Most of the 38 locations said the school-based clinics were a useful vaccination method but said they would not hold them in the future without additional resources.

About 42% of the children vaccinated at the sites received the nasal mist form of the vaccine, and 59% received the injection. Reviewers noted that three of the six localities reported decreased demand for the nasal mist version, due to parent and staff misconceptions about its safety, which were driven by incorrect media messages that the nasal mist was riskier because it contained a live attenuated virus.”

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About

This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.

Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner. (For those wishing to see pictures of a 2009 Friends of Liberia service trip to this West African country, please visit www.fol.org. My photo album is included).

Do you have an informational question in the health/medical area?
Email me at jmflahiff@yahoo.comI will reply within 48 hours.

My professional work experience and education includes over 10 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.

While I will never be be able to keep up with the universe of current health/medical news,
I subscribe to the following to glean entries for this blog

Krafty (Medical)Librarian,” a collection of writings from Michelle Kraft on items of interest to medical librarians. She tends to write on technology and medical libraries but she also writes about things in general on librarianship, medicine and health”

Free Government Information, a “place for initiating dialogue and building consensus among the various players (libraries, government agencies, non-profit organizations, researchers, journalists, etc.) who have a stake in the preservation of and perpetual free access to government information”

Scout Report, a “weekly publication offering a selection of new and newly discovered Internet resources of interest to researchers and educators”